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在人体实验室疼痛模型中对大麻二酚和氢吗啡酮联合作用进行的一项受试者内、双盲、安慰剂对照随机评估。

A within-subject, double-blind, placebo-controlled randomized evaluation of the combined effects of cannabidiol and hydromorphone in a human laboratory pain model.

作者信息

Bergeria Cecilia L, Mun Chung Jung, Speed Traci J, Huhn Andrew S, Wolinsky David, Vandrey Ryan, Campbell Claudia M, Dunn Kelly E

机构信息

Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States.

Edson College of Nursing and Health Innovation, Center for Health Promotion and Disease Prevention, Arizona State University, Tempe, AZ, United States.

出版信息

Pain. 2025 Feb 28;166(9):e175-e184. doi: 10.1097/j.pain.0000000000003561.

Abstract

Preclinical and epidemiological evidence supports that cannabinoids may have opioid-sparing properties and could be one strategy to decrease opioid use and associated harms like overdose and extramedical use. The objective of this within subjects, double-blind, double-dummy, randomized human laboratory trial was to examine whether cannabidiol (CBD) increases opioid analgesic effects and whether there are corresponding increases in other opioid mediated effects. Healthy participants (N = 31) attended 5 outpatient sessions where they received the following drug conditions: (1) placebo + placebo, (2) 4 mg hydromorphone + placebo, (3) 4 mg hydromorphone + 50 mg CBD, (4) 4 mg hydromorphone + 100 mg CBD, and (5) 4 mg hydromorphone + 200 mg CBD. Before and at multiple time points after drug administration, participants completed (1) quantitative sensory testing, which induced and assessed acute and chronic laboratory models of pain; (2) standard assessments, which queried acute subjective drug effects; and (3) tasks, which assessed psychomotor performance. When combined with a dose of hydromorphone that did not reliably produce analgesic effects on its own, CBD increased the analgesic effects for some laboratory acute pain outcomes but none of the laboratory chronic pain outcomes. At the highest dose of CBD (200 mg), there were concurrent increases in self-report Bad Effects and adverse effects that were not observed at lower doses of CBD (50 mg). Cannabidiol mitigated psychomotor impairment observed with hydromorphone alone. These findings suggest that lower doses of CBD (50 mg) may have utility for enhancing acute analgesic properties of opioids without having corresponding increases in bad effects.

摘要

临床前和流行病学证据支持,大麻素可能具有减少阿片类药物使用的特性,并且可能是一种减少阿片类药物使用及其相关危害(如过量使用和非医疗用途)的策略。这项受试者内、双盲、双模拟、随机人体实验室试验的目的是研究大麻二酚(CBD)是否能增强阿片类药物的镇痛效果,以及其他阿片类药物介导的效应是否也会相应增加。健康参与者(N = 31)参加了5次门诊,接受以下药物治疗:(1)安慰剂+安慰剂,(2)4毫克氢吗啡酮+安慰剂,(3)4毫克氢吗啡酮+50毫克CBD,(4)4毫克氢吗啡酮+100毫克CBD,以及(5)4毫克氢吗啡酮+200毫克CBD。在给药前和给药后的多个时间点,参与者完成了以下测试:(1)定量感觉测试,该测试诱导并评估急性和慢性疼痛实验室模型;(2)标准评估,该评估询问急性主观药物效应;以及(3)任务,该任务评估心理运动表现。当与单独使用时不能可靠产生镇痛效果的氢吗啡酮剂量合用时,CBD对一些实验室急性疼痛结果增强了镇痛效果,但对任何实验室慢性疼痛结果均无增强作用。在最高剂量的CBD(200毫克)下,自我报告的不良效应和不良反应同时增加,而在较低剂量的CBD(50毫克)下未观察到这种情况。大麻二酚减轻了单独使用氢吗啡酮时观察到的心理运动损害。这些发现表明,较低剂量的CBD(50毫克)可能有助于增强阿片类药物的急性镇痛特性,而不会相应增加不良效应。

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